COPD is a symbol whose meaning is Obstructive Pulmonary Disease Chronic. This abbreviation comprises two diseases that are chronic bronchitis and pulmonary emphysema. By the way, every time we meet up with the acronym COPD should bear in mind that we are talking about a syndrome that is divided into pathologies.

COPD is the fourth leading cause of death worldwide, and the World Health Organization (WHO) estimates that in 2020 will be the third if we continue with the current growth levels of smoking.

As smoking is a habit and overall social and produces a widespread disease occurring in the long run in the life, this indicates why the great concern of WHO, and also in Brazil, the National Cancer Institute (INCA) declared it has caused and continues unfortunately with potential to cause even greater number of fatalities and serious repercussions for public health.

The estimated annual cost of COPD in America is US.$ 32.1 billion, and 70% of these costs are related to acute exacerbations that require hospitalization. Acute exacerbationsare the most important cause of mortality and morbidity in patients with COPD. A recent prospective study showed that COPD exacerbation rate has in-hospital mortality of 8% and a mortality rate of 23% for patients outside of nosocomial (Hospital Environment).

Not only is the existence of the cigarette in its rudimentary form, exemplified by the straw cigarettes, also known as “bindis” in some parts of the world,as for example,in India. The commercial cigarettes, with their industry with distribution strategy and marketing very well defined and for the general public, but with particular preferred target and cruelly for young people and women, we have the existence of electronic cigarettes, that contrary to claims that manufacturers generally Chinese, do not release only water vapor, for analysis of U.S. government of the two brands sold in that country showed the presence of several toxic chemicals and carcinogens such as nitrosamine and diethylene glycol.

All these factors lead to a pessimistic future pointing, as aforesaid, into the statistics of WHO estimates that in 2020 COPD will be the third cause of mortality. We repeat this on purpose because it is completely incomprehensible that this prediction will come true, since it is an avoidable disease. Stop the realization of this estimate is our duty, read the whole society, not just organizations that protect human health, which THE PULMAO S.A.humbly includes itself.

This is one of the concerns of the millennium, and therefore given its reach in financial responsibility, social, environmental and citizen belongs to all of us humans. The gratitude to this task still can not be heard. But you can be sure that will come in the voices of people very familiar: Our own descendants!

Join! Get involved in this cause; after all it is yours too!

But why the exacerbation of COPD leads to mortality?

The test that measures lung function called spirometry. It is through this test that pulmonologists can measure the functional capacity of the lungs. We know that with the natural aging of the people the ability of pulmonary function decline. However, this is a normal decline, called physiologic. The smoker then presents two factors for the function decline :

1. The physiological decline, with the normal development of age;
2. The decline caused by smoking which adds to the physiological decline, and may be accelerated with exacerbations (periods of “worse”) of COPD.

Therefore, we established a concept: patients with frequent exacerbations of COPD suffer a decline in lung function more quickly, which translates into a poorer quality of life compared with those who have fewer exacerbations.

CAUSES OF EXACERBATION

the most common cause of exacerbation of COPD is associated with viral respiratory infections and bacterial infections acquired in the community. Effective treatments to manage exacerbations caused by infections are becoming limited. Therefore, if we identify evidence-based strategies, to prevent exacerbations of COPD, this will have a significant impact in reducing mortality and morbidity.

This identification is usually perceived by the medical professional. Meanwhile, to clarify this situation for patients, through continuing education to patients, it is also crucial so that we can stall the progress of this disease, which, by the way, is preventable, is one of the missions PULMAO S.A. in order to collaborate with the protection of global health, and particularly of all Brazilians.

And as our own slogan expresses the function of PULMAO S.A. is to be an agent responsible in safeguarding its atmosphere.

Vaccines & COPD

The introduction and widespread use of vaccines has made great strides in preventing disease, disability and death from infectious diseases. The guidelines of the Brazilian Consensus on COPD recommend that all patients with COPD, as well as other groups at high risk receive influenza vaccination annually [1]. The Center for Disease Control (CDC) recommends that the pneumococcal vaccine is administered to all patients with at least 65 years of age and for younger patients and those with chronic diseases, including COPD [2].
AVIAN

Influenza is an acute febrile illness caused by these types of influenza viruses: A, B and C. The influenza virus belongs to the family Orthomyxoviridae. The influenza A viruses can infect several species of animals (birds, chickens, ducks, pigs, horses, whales, etc.). Influenza B and C basically infect humans. Influenza A and B are capable of causing epidemics, as this new influenza A or swine. The influenza C virus has epidemic potential, and generally causes less severe disease [3].

Since 1977 it is observed that the influenza virus A (H1N1), influenza A (H3N2) and influenza B viruses have been circulating around the world causing seasonal epidemics, resulting in significant morbidity and mortality. Influenza infects an average of 5-20% of the population of the United States each year. The total estimated annual number of hospitalizations associated with influenza in the United States ranged from approximately 55,000 to 431,000 (average: 226. 000) [4]. It is estimated that the annual number of deaths attributed to flu season from 1990-1991 to 1998-1999 ranged from 17,000 to 51,000 (average: 36. 000) [4].

Vaccines for influenza began to be developed in 1940.As formulations of influenza vaccine today are trivalent (2 serotypes of influenza A virus: H1N1, and H3N2, another serotype B), in view of the global circulation of these serotypes and given the possibility of mutation, suffer annual updates, which explains why the annual revaccination of the same.

They are known as TIV, English Trivalent Inactivated Viral administered intra muscular and do so in Brazil. There is a second type of influenza vaccine called LAIV (trivalent inactivated viral cold adapted), with intranasal administration and in healthy subjects used in the range of 2 -49 years, available in the U.S. [5]. There is no security set for use in COPD patients of LAIV.

The TIV is administered intramuscularly, and is the most commonly used, including in Brazil, can be used by anyone at least 6 months of age, including those with high risk conditions such as COPD. The vaccine, being produced with inactivated split-virus, can be administered safely in people with immune system deficiencies and, if administered to pregnant women, no risk to the fetus.

We Should protect those with allergies to albumin (egg white), as it is developed from virus grown in chicken eggs, as well as those with allergy to neomycin and thimerosal (Merthiolate ® Constituent), since the vaccine may contain traces of these substances.

During the 2007-2008 season, the circulating strains included in the southern hemisphere in 2009, upon recommendation of WHO as we have said is composed of 2 serotype A and serotype B 1:

1.A/Brisbane/59/2007 (H1N1),

2. A / Brisbane / 10/2007 (H3N2),

3. one serotype B: B/Florida/4/2006 [6].

The fact of the seasonal vaccine contain different serotypes and one of them is an H1N1, we do recommend the vaccine against seasonal influenza as a useful tool in defending against the new strain H1N1/Influenza A, responsible for the flu suína.A explanation for this is the possibility there crossed response from the immune system, since these H1N1, contains some percentage of identity genomics.

The fact that the elderly, this new influenza A, have a lower mortality makes us wonder why disto.Há have theories as to evoke:

a) Answer given cross-contact of these now elderly with other types of viral influenza in previous epidemics such as Asian and 1957 Hong Kong in 1968;

b) The fact that the elderly are being vaccinated against seasonal flu each year, and therefore in touch every year, just by the vaccine, with 3 different serotypes.

Given that the morbidity and mortality of influenza are particularly high in people with COPD, influenza vaccination is recommended for patients with COPD [7]. It is noteworthy that these recommendations are based largely on the evidence observational studies. For example, in a large series study of a cohort of approximately 150 000 elderly patients, those who received influenza vaccine had a 32% reduction in hospitalization rates for all respiratory conditions and a reduction of approximately 50% in mortality all causes, compared with patients who received the vaccine [8]. In the subgroup of elderly patients who had chronic lung disease, patients who received influenza vaccine had a 52% reduction in hospitalization and 70% reduction in risk of death [9].

The impact of influenza vaccination is clearly related to the incidence of influenza among people with COPD. Wongsurakiat et al. [10] recently estimated that influenza is responsible for about 8% of all acute exacerbations of COPD. However, the flu can be held responsible for causing more than 35% of exacerbations of COPD during epidemics, like that of swine flu / influenza A/H1N1 [11].

Pneumococcal Vaccine

Streptococcus pneumoniae, also known as pneumococcus, a bacteria encapsulated “coconut Gram-positive” that often colonizes the nasopharynx of healthy children and adultos. The Pneumococcal is spread from person to person as a result of extensive contact [12].

People with immunological impairment, whether congenital or acquired, are particularly susceptible to infection by pneumococcal. A pneumococcal infection can manifest in a variety of clinical syndromes, including: otitis media, sinusitis, pneumonia, empyema, peritonitis, septic arthritis, osteomyelitis, and in rare cases, endocarditis and pericarditis.

Since COPD disease causes a chronic bronchial inflammation and results in obstructive process, patients with COPD are unusually prone to develop infections and other complications by pneumococcal. The COPD patients develop a chronic colonization of the lower respiratory tract by bacteria, including S. pneumoniae and Haemophilus influenzae [13].

These acute exacerbations of COPD patients require systemic and inhaled corticosteroids that can impair the immune response and predispose patients to pneumococcal infection. Not surprisingly, S. pneumoniae is the organism most frequently isolated in patients with COPD with pneumonia in episodes of acute exacerbations [14].

In a retrospective cohort study with 1898 elderly patients with chronic lung disease, Nichol et al. [15] demonstrated that the pneumococcal vaccine results in a reduction of hospitalization for pneumonia in 43% and a reduction of up to 29% mortality in these patients. This result makes the recommendation of the pneumococcal vaccination is recommended by several consensus as part of routine management of people with COPD [16,17].